Telehealth: A proactive, value-based solution to the US physician shortage

The U.S. population's shifting age demographics have created a need for more proactive care. Three million baby boomers are estimated to reach retirement every year for the next 20 years, according to Advisory Board. Additionally, 33 percent of adults are identified as obese, according to the CDC. Both trends highlight the growing need for chronic illness management and proactively reaching patients before they present at the hospital.

Additionally, it is estimated that around 20 percent of patients live in areas with an insufficient number of primary care physicians. A more striking number comes from the Association of American Medical Colleges which projects there will be a shortage of 45,000 primary care physicians by 2020. When considering the nation's changing demographics and imminent physician shortage, which some hospitals are already experiencing, it's clear the current model of healthcare delivery is unsustainable.

These trends are contributing to the growing popularity of telemedicine and virtual care visits. During a May 16 webinar presented by Becker's Hospital Review and sponsored by NTT Data, Jordana Bernard, director of policy and public affairs at InTouch Health; Atul Kichambare, global solutions leader for NTT Data; and Christian Dye, senior management consultant at NTT Data, discussed the growing demand for telemedicine and how providers can get reimbursed for the virtual services provided.

Growing demand for telemedicine

Patients are increasingly becoming supporters of telemedicine solutions. A survey, cited by NTT Data, found that 70 percent of consumers would rather have an online video visit to obtain a prescription than travel to a physician's office. Similarly, 64 percent said they would be willing to have a video visit with a physician.

What's pushing hospitals and health systems to invest in telehealth are the obvious gaps in care and patient demand. The NTT Data-reported survey found 30 percent of parents with children under the age of 18 would prefer a video visit with a physician in the middle of the night instead of traditional options, which include emergency room visits.  

However, even though there has been a 68 percent increase in the number of employers offering telemedicine, healthcare organizations still face barriers to adoption.

"The No. 1 issue executive's face when adopting telehealth solutions is regulatory and reimbursement hurdles,"Mr. Kichambare said. "There is a lot of confusion and struggle to keep up with ever-changing federal and state regulations. Matching current level of reimbursement with the services being delivered virtually is critical to ensure financial success."

Telehealth of yesterday, today and tomorrow

In 1997, the federal government passed a law on telemedicine under the Social Security Act. Under the legislation, telemedicine reimbursement was limited to specific qualifications, including location and kind of service provided. For providers to be reimbursed, patients had to be in a medical facility located in a rural area. Additionally, only real-time interactive audio/video services could be reimbursed.

Fast forward to 2017-18, members of Congress began introducing more and more legislation to expand reimbursement for telehealth services. In 2017-18, there was a 48 percent spike in the amount of federal telehealth-related legislation that was introduced compared to the previous Congress.

"The enacted legislation mainly focused on expanding Medicaid coverage, establishing regulatory requirements and enacting inter-state licensure compacts," Ms. Bernard said. "In 2018, 38 states finalized 49 telehealth-related regulations, which were focused on practice standards. And by the end of 2018, every state had established some coverage in reimbursement for telehealth under Medicaid."

With momentum building, four major pieces of telehealth legislation were passed by the end of 2018. The various bills were sweeping, giving veterans access to telehealth services and covering telebehavioral health services for patients with substance use disorders. As of Jan. 1, telestroke and end-stage renal disease home dialysis services were granted nationwide Medicare coverage along with expanded coverage for remote patient monitoring (RPM) services. This expansion of reimbursement for telehealth and RPM services means the role of these remote delivery models in healthcare's shift toward value-based care is poised to expand.

"Now, telehealth is going to play a larger role in value-based models," Mr. Dye said. "We are hoping to see telehealth drive better, more efficient and lower cost care."

By adopting telehealth solutions, providers can offer patients increased access to higher quality care. To ensure success on the path to value-based care, hospitals and health systems need to adopt virtual care tools as a proactive solution to healthcare's ongoing and future challenges.  

To view the webinar, click here.

To learn more about NTT Data, click here.

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